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Emerg Med J 2009;26:254-258 doi:10.1136/emj.2007.053298
  • Original Article

Prediction of mortality in adult emergency department patients with sepsis

  1. C Vorwerk1,
  2. B Loryman2,
  3. T J Coats1,
  4. J A Stephenson3,
  5. L D Gray2,
  6. G Reddy4,
  7. L Florence5,
  8. N Butler6
  1. 1
    Emergency Department Academic Unit, Leicester Royal Infirmary, Leicester, UK
  2. 2
    Emergency Department, Leicester Royal Infirmary, Leicester, UK
  3. 3
    Department of Surgery, Leicester General Hospital, UK
  4. 4
    Department of Surgery, Airedale General Hospital, Keighley, UK
  5. 5
    Department of Medicine, Leicester Royal Infirmary, Leicester, UK
  6. 6
    Department of Surgery, The Prince Charles Hospital, Brisbane, Australia
  1. Dr C Vorwerk, Emergency Department Academic Unit, Leicester Royal Infirmary, Leicester LE1 5WW, UK; cv28{at}le.ac.uk
  • Accepted 13 July 2008

Abstract

Objectives: To determine the efficacy of the abbreviated Mortality in Emergency Department Sepsis (MEDS) score, the Modified Early Warning (MEW) score and near-patient-test (NPT) lactate levels in predicting 28-day mortality in adult emergency department (ED) patients with sepsis.

Methods: A retrospective cohort study of adult ED patients with sepsis admitted to hospital was conducted in a large urban teaching and a district general hospital. Data were collected during four time periods between 1 January 2006 and 31 January 2007. Inclusion criteria were age ≥16 years and an ED diagnosis of sepsis. Primary outcome for all patients was 28-day mortality. Patients were preassigned to risk groups according to their abbreviated MEDS score, MEW score and NPT lactate.

Results: 307 ED patients with sepsis were included in the study. Among these there were 72 deaths (23%). Mortality rates for the low-, moderate- and high-risk groups of the abbreviated MEDS score were 1/63 (1.6%), 48/205 (23.4%) and 23/39 (59.0%) patients. The MEDS score for low-risk patients was 98.6% (95% CI 92.5% to 99.9%) sensitive and 26.5% (95% CI 21.0% to 32.6%) specific and for high-risk patients it was 31.9% (95% CI 21.4% to 44.0%) sensitive and 93.2% (95% CI 89.2% to 96.1%) specific for death within 28 days. Mortality rates for the low- and high-risk MEW score were 20/159 (12.6%) and 52/148 (35.1%) patients. The MEW score for high-risk patients was 72.2% (95% CI 60.4% to 82.1%) sensitive and 59.2% (95% CI 52.6% to 65.5%) specific for mortality. An NPT lactate level of ≥4 mmol/l was 49.1% (95% CI 35.1% to 63.2%) sensitive and 74.3% (95% CI 64.8% to 82.3%) specific for 28-day mortality.

Conclusion: These results demonstrate the efficacy of the abbreviated MEDS score, the MEW score and NPT venous lactate levels in predicting 28-day mortality in ED patients with sepsis. The abbreviated MEDS score was found to be the best performing risk assessment model which, with prospective validation, may aid early clinical decision-making in ED patients with sepsis and might affect the outcome from sepsis.

Footnotes

  • Funding: None.

  • Competing interests: None.

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